While coding an "Interlaminal epidural steroid injection at the T12-L1 level on the left", I was not sure which of the CPT codes to use, 62310 or 62311? Our 'pain guru' had put out a note that 'ANY INJECTION AT T12-L1 SHOULD BE CODED AS A THORACIC INJECTION'. Does anyone know where this is written for validation?

I dont see anything in CPT, but based on guidelines for other codes (64633-64635 is one example) I would think that you would bill the thoracic. the RFA codes state the same thing as your "pain guru's" note, if it's T12-L1, you use the cervical/thoracic code. not sure why though. I would bill based on the note you were given, and if it's denied call the carrier and find out why, maybe they'll be able to give you the correct guidelines? hope I could help at all.

Here's an article that agrees with using the thoracic code for the T12-L1 injection...I knew I'd seen it somewhere before, just had to track it down

Published in Anesthesia Coding Alert, August 2011
Question: Our pain management specialist administered an interlaminar epidural injection to the patient's T12-L1 joint. Do we consider this a thoracic or lumbar injection for coding?
Wyoming Subscriber
Answer: Consider the procedure a thoracic injection and report 62310 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic).
Explanation: CPT 2010 [...]

I tried look at the link but it wont show the explanation, we have a subscription to supercoder but it says thats outside our selected specialties. dont suppose you could copy/paste the explanation for us could you? I'd be interested to read why that is.

What I have posted above is all that I could access also; we don't subscribe to it at all, but that part was viewable in a google search.
However, I really think I've read the same info somewhere else, just haven't been able to find it yet. I'm going to keep looking though, and will post any other info I can find about it.

Here is the full Q and A.
Published in Anesthesia Coding Alert, August 2011

Question: Our pain management specialist administered an interlaminar epidural injection to the patient's T12-L1 joint. Do we consider this a thoracic or lumbar injection for coding?

Wyoming Subscriber

Answer: Consider the procedure a thoracic injection and report 62310 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic).

Explanation: CPT 2010 guidelines mandated that you report 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) for a facet injection to the T12-L1 joint, or nerves innervating that joint. New 2011 guidelines direct you to submit 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single) instead for a facet injection to the same area. That same mindset â€ť reporting a cervical/thoracic code for a facet injection to T12-L1 also applies to other injection approaches to the vertebral interspace.

Bonus: At first glance, another code choice might be 64479 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single level). The provider must use a transforaminal approach at the T12-L1 foraminal opening, however, before you can submit 64479.

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